Download TНЕМЕ: "PATHOLOGY OF HYPOTHALAMO

TНЕМЕ: "PATHOLOGY OF HYPOTHALAMO-PITUITARY SYSTEM".
Actuality of theme. Differentiation of cells with formation of tissues and
organs which execute the specialized physiology functions is the qualificatory feature
of human organism. Regulation of all vital functions of an organism carried out by
the nervous and endocrine systems. The action of the last will be realized due to a
secretion and transporting of specific humoral factors of distance action - hormones.
Violation of hormones formation or transporting results in various disorders of the
humoral regulation of an organism.
It is extraordinarily important to know etiological factors which result in the
origin of hvpo- hyper- and dysfunctions of endocrine organs for a future specialist.
Understanding of mechanisms of basic manifestations at endocrine pathology
development is a necessity for the doctor of any profession, taking into account that
violation of the hypothalamus-pituitary regulation results in the origin of pathology
from the side of various organs and systems of adult and child organism.
Epiphysis also takes place at the endocrine regulation except the hypothalamopituitary system. Pathology of epiphysis is well not yet studied enough at human.
However the role of gland in regulation of sexual development, management of man
daily allowance rhythms is well known. Therefore knowledge of etiology and
pathogenesis of hyper- and hypofunction of epiphysis development is a necessity for
the specialist of modern level.
General purpose of the lesson. To learn reasons and mechanisms of violations
development at pathology of hypothalamo-pituitary systems.
For this it is necessary to know (the concrete purposes):
 To use a basic concept about endocrine function for the characteristics of
typical violations of the endocrine glands;
 To explain the causes and general mechanisms of primary and secondary
endocrinopathology;
 To describe neuro-endocrine pathology causes and mechanisms of its
development;
 To analyze the consequences of violations of adenohypophysis hormones
secretion;
 To analyze the consequences of violations of neurohypophysis hormones
secretion;
 To explain the reasons of primary and secondary hyper-and hypofunction of
adrenal cortex;
For realization of purposes of lesson1 it is necessary to have the base knowledgesskills:
1. To know the structure (anatomy) of hypothalamus and hypophysis (normal
anatomy department);
2. To know the mechanisms of hormones action (physiology and
bioclemistry departments);
To know the hormonal regulation of metabolism and biological functions of cells
(biochemistry department).
3.
The checking of primary level of knowledges.
Give the answers to the following questions:
1. Name the hormones which are produced by the adenohypophysis.
2. Name the hormones which are produced by a neurohypophysis.
3. Name clinical state connected with low level of adenohypophysis hormones?
4. Name clinical state connected with high level of adenohypophysis hormones?
5. Definition of partial hypopituitarism?
6. Name hormone, related with acromegaly? Define the level of this hormone
(increased or diminised)
7. Name hormone, related with pituitary gigantism?
8. Name hormone, related with does pituitary nanism?
9. Name hormone, related with Cushing's disease?
10. Name hormone, related with the Parhon's syndrom?
11. Name hormone, related with the diabetes insipidus?
12. Name hormone, related with the long-lasting lactation syndrome?
Standards of answers at the theoretical questions of initial level of knowledges:
1.
Somatotropin (growth hormone? STH), adrenocorticotropin (ACTH),
thyrotropin (TTH), gonadotropic hormones (follicle-stimulating hormone, luteinizing
hormone), melanotropic hormone, lactotropic hormone;
2.
Vasopressin, oxytocin;
3.
Hypopituitarism – low production of certain hormones; panhypopituitarism –
low level of all adenjhyphysal hormones
4.
Hyperpituitarism;
5.
It is diminishing or absence of some of adenohypophysis hormone synthesis;
6.
The acromegaly develops as a result of increased production of somatotropin
(STH) at adults;
7.
The pituitary gigantism develops as a result of increased production of
somatotropin (STH) at children;
8.
Pituitary nanism develops as a result of diminishing production of
somatotropin (STH) at children;
9.
Cushing’s disease develops as a result of increased production of
adrenocortocothropin (ACTH);
10.
The Parhon's syndrome develops as a result of increased production of
vasopressin
11.
Diabetes insipidus develops as a result of decreased production of
vasopressin;
2
12.
The long-lasting lactation syndrome develops as a result of increased
production of the lactotropic hormone and does not connect with pregnancy and
physiological lactation.
Theoretical questions for FMC -2.
1. General characteristic of the endocrine system disorders: hypofunction, hyperfunction,
dysfunction of the glands, primary, secondary endocrinopathy.
2. Causes and mechanisms of endocrinopathies. Dysregulatory endocrinopathy: disorders
of the nervous, neuroendocrine, endocrine and metabolic regulation of the endocrine
glands. Violation of direct and inverse regulatory relations.
3. Glandular endocrynopathy: causes and mechanisms of synthesis , deposition and
secretion of hormones disorders
4. Peripheral disorders of endocrine function. Violation of transporting and
metabolic inactivation of hormones.
5. Violation of the reception of hormones and hormonal mechanisms of resistance
(prereceptor, receptor, postreceptor).
6. Pathology of the hypothalamic-pituitary system. Causes and mechanisms of
syndromes of excess and lack of pituitary hormones synthesis.
7. General characteristic of the hypothalamic-pituitary-thyroid, hypothalamicpituitary-adrenal, hypothalamic-pituitary-gonad system.
8. Etiology, pathogenesis, clinical manifestations of panhypopituitarism.
9. Causes, mechanisms of development, clinical manifestations of partial
adenohypophysis failure (insufficiency of STH, TTH, ACTH, gonadotropins).
10.Etiology, pathogenesis, clinical manifestations of partial hyperfunction of
adenohypophysis (STH, TTH, ACTH, gonadotropins, prolactin).
11.Pathophysiology of the neurohypophysis.
12.Diabetes insipidus: causes and mechanisms of development, clinical
manifestations.
Themes of reports:
 Role of epiphysis in the hormonal regulation.
 Pathology of intracellular mediators systems of hormones action.
 Psychogenic endocrinopathies.
 Parhon's syndrome. Etiology, pathogenesis, charactaristic.
 Shihan's syndrome. Etiology, pathogenesis, basic manifestations,
consequences.
1.
2.
3.
4.
Literature.
Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005.
General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011
p.520-546
Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237
Lectures materials
3
Tests from Open database "KROK-1" (2010)
1. A 32-year-old woman complains about the absence of lactation after
parturition. Such disorder might be explained by the deficit of the following
hormone:
A
Prolactin
B
C
D
E
Somatotropin
Vasopressin
Thyrocalcitonin
Glucagon
2. Examination of a patient revealed overgrowth of facial bones and soft tissues,
tongue enlargement, wide interdental spaces in the enlarged dental arch. What
changes of the hormonal secretion are the most likely?
A
Hypersecretion of the somatotropic hormone
B
Hyposecretion of the somatotropic hormone
C
Hypersecretion of insulin
D
Hyposecretion of thyroxin
E
Hyposecretion of insulin
3. A patient has a decreased vasopressin synthesis that causes polyuria and as a
result of it evident organism dehydratation. What is the mechanism of polyuria
development?
A
Reduced tubular reabsorption of water
B
Reduced tubular reabsorption of Na + ions
C
Reduced tubular reabsorption of protein
D
Reduced glucose reabsorption
E
Acceleration of glomerular filtration
4. A man after 1,5 liter blood loss has suddenly reduced diuresis. The increased
secretion of what hormone caused such diuresis alteration?
A
Vasopressin
B
Corticotropin
C
Natriuretic
D
Cortisol
E
Parathormone
5. Rentgenological examination of skull base bones revealed enlargement of
sellar cavity, destruction of different parts of sella turcica. Such bone
destruction might be caused by a tumor of the following endocrine gland:
A
Hypophysis
B
Epiphysis
C
Thymus gland
D
Adrenal glands
E
Thyroid gland
4
6. A 46 year-old patient has complained of headache, fatigue, thirst, pains in the
spine and joints for the last 2 years. Clinically observed disproportional
enlargement of hands, feet, nose, superciliary arches. He notes that he needed to
buy bigger shoes three times. What is the main reason of such disproportional
enlargement of different parts of the body?
A
B
C
D
E
Cartilaginous tissue proliferation under growth hormone influence
Increased sensitivity of the tissues to growth hormone
Joints dystrophy development
Increased sensitivity of the tissues to insulin
Joints chronic inflammation development
7. A woman after labor lost 20 kg of body weight, her hair and teeth fall out, she
has muscle atrophy (hypophysial cachexia). Synthesis of what hypophysis
hormone is disturbed?
A
Somatotropic
B
Corticotrophic
C
Thyreotropic
D
Gonadotropic
E
Prolactin
8. Examination of a patient revealed enlargement of some body parts (jaw, nose,
ears, feet, hands), but body proportions were conserved. It might be caused by
intensified secretion of the following hormone:
A
Somatotropin
B
Somatostatin
C
Tetraiodothyronine
D
Triiodothyronine
E
Cortisol
Testing according system “Krok-I” (2006-2010)
1. Analysis of urine from a 24-year-old man revealed the following changes:
daily diuresis-10 l, relative density – 1,001, qualitative changes are absent. A patient
complains of excessive thirst, frequent urination. What is the most likely cause of this
disease?
A. Relative insulin insufficiency
B. Aldosteron hypersecretion
C. Vasopressin hypersecretion
D. Glucocorticoid hypersecretion
E. *Vasopressin hyposecretion
2.A 35 year old patient complains about permanent thirst, poor appetite. He drinks 9
liters of water per day. Daily diuresis is increased, urine is colorless, its specific
gravity is 1,005. The most probable cause of this pathology development is damage
5
of:
A. Epithelium of renal tubuli
B. Basal membrane of glomerular capillaries
C. Hypothalamic nuclei
D. Epiphysis
E. *Hypothalamic nuclei
3.A 20 y.o. patient complains about morbid thirst and profuse urination (up
to 10 1 a day. Glucose concentration in blood is normal, in urine glucose is absent.
Such condition may be caused by deficiency of the following hormone:
A. Oxytocin
B. Cortisol
C. Insulin
D.*Vasopressin
E. Triiodthyronine
4. A patient has a decreased vasopressin synthesis that causes polyuria and as a
result of it evident dehydratation. What is the mechanism of polyuria
development?
A *Reduced tubular reabsorption of water
B Reduced tubular reabsorption of Na- ions
C Reduced tubular reabsorption of protein
D Reduced glucose reabsorption
E Acceleration of glomerular filtration
5. X-ray examination of skull base bones revealed enlargement of sellar cavity,
destruction of parts of sella turcica. Such bone destruction might be caused by a
tumor of the following endocrine gland:
A *Hypophysis
B Epiphysis
C Thymus gland
D Adrenal glands
E Thyroid gland
6. In a patient, 40 years old, polyuria (10 - 12 liters per day) and polidypsia
occurred due to the damage of supraoptic and paraventricular nuclei of the
hypothalamus. Lack of which hormone causes these disorders?
A. * Vasopressin
B. Oxytocin
C. Cortikotropin
D. Somatotropin
E. Thyrotropin
7. Patient K., aged 35, complained6 of constant thirst, decreased appetite. Amount
of liquid drunken in a day - 9 liters. Daily urine output increased, discolored
urine, the relative density - 1005. The most likely cause of this pathology in a
patient is damaged:
A. * hypothalamic nuclei
B. epithelium of renal tubules
C. adenohypophysis
D. epiphysis
E. basal membrane of glomerular capillaries
8. Patients V., 46 years, displayed a disproportionate increase in the hands, feet,
nose, ears, superciliary arches and the zygomatic bone. Blood test hyperglycemia, breach of glucose tolerance test. The most likely cause of this
pathology is:
A. * hypersecretion of somatotropin
B. hypersecretion of adenohypophysis hormones
C. hyposecretion of insulin
D. .hyposecretion of vasopressin
E. hypersecretion of glucocorticoids
9. A 27 year old man came to the doctor. Examination revealed increased size of
palms, feet and lower jaw. Also, deformation of the joints (kiphosis), hormonal
disorders (impotence, testicular atrophy) were observed. Functions of which
gland are affected?
A. * Front pituitary
B. Adrenal glands
C. epiphysis
D. Thyroid
E. Parathyroid
10. A patient with damage to the back of pituitary developed increased daily diuresis
to 10-15 liters. What is the principal mechanism in the polyuria development?
A. * Deficiency of vasopressin
B. Increased secretion of vasopressin
C. Increased secretion of aldosterone
D. Malfunction of atrial natriuretic factor
E. Reduced corticotropin level
11. A woman following the childbirth has lost 20 kg of weight, teeth and hair are
falling out, there is muscle wasting [hypophysial cachexia]. With synthesis
dysfunction of which pituitary hormone is this connected?
A. * Somatotrophic
B. Kortykotrophic
C. Thyrotrophic
D. Gonadotrophic
E. Prolactin
7
Situation tasks:
1. Examination of a teenager revealed that his height lower than age norm,
mental development is normal.
1. Name the reasons of this state?
____________________________________________________________________
________________________________________________________________
2. Name the functions of this hormone.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
________________________________________________________________
2. Examination of a 60 years old patient revealed increasing of separate parts of
body - bottom jaw, nose, tongue, arms and feet, intervals between the teeth of
bottom jaw are increased
1. Name the reason of such state?
____________________________________________________________________
__________________________________________________________________
2. Mechanisms of development of the clinical signs.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
__________________________________________________________________
3. Woman, 25 years, through 2 months after difficult delivery complicated with
considerable bleeding, appealed to doctor-endocrinologist with complaints about
acute weight loss, decline of appetite, absence of lactation, apathy, somnolence,
weakening of memory, fragility of nails, dryness of skin. Objectively: AP - 90/60
mm. Hg, pulse - 55/min, signs of senilism (ageing).
1. Name this pathology?
____________________________________________________________________
____________________________________________________________________
________________________________________________________________
2. Identify main reasons and mechanisms of development of the indicated signs.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
_______________________________________________________________
4. Parturient woman on the 5 day after the labor has an agalactia (absence of
breast milk).
I. Name the place of this hormone production and its biological effects.
____________________________________________________________________
8
____________________________________________________________________
________________________________________________________________
____________________________________________________________________
_______
5. Absence of labor activity is observed at the expectant mother after discharge
of amniotic fluid.
1. Reasons of this pathology?
____________________________________________________________________
____________________________________________________________________
2. Name the place of this hormone production and its biological effects.
____________________________________________________________________
____________________________________________________________________
6. Polydipsia, polyuria (day's diuresis is 25 litres), specific gravity of urine - 1002
is observed at a boy after the viral infection.
1. Name the pathology for a patient?
____________________________________________________________________
____________________________________________________________________
2. Specify the reasons and mechanisms of the indicated signs development.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
7. Parents, disturbed by the extraordinarily high height of the 15-years-old son
(205 sm) and delay of the puberty, appealed to doctor-endocrinologist.
1. With what hormone related this pathology? Name possible reasons?
____________________________________________________________________
____________________________________________________________________
2. Name the place of this hormone production and its biological effects.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
8. A district pediatrician at a duty prophylactic review educed two children with
a low height. In first case - a boy with the low height, but mental development is
corresponding to age. In second case - a girl has low physical and mental
deviation.
1. What pathology is observed in first9and second case?
____________________________________________________________________
____________________________________________________________________
2. What are the reasons and mechanisms of development?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
9. The doctor educed a 3-years-old boy who was higher than all 6-years-old
children at the examination.
1. Name hormone, related with this state?
____________________________________________________________________
____________________________________________________________________
2.
Name pathology? Reasons and mechanisms of development.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
10. A man appealed to the doctor with complaints about the increasing of nose,
ears, tongue, superciliary arcs, bottom jaw and arms. Objectively - glucose on an
empty stomach is 7,4 mmoI/1, after the glucose overloading -15,2 mmol/1.
1. What pathology is observed for a patient?
____________________________________________________________________
____________________________________________________________________
2. What are the reasons and mechanisms of it development?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
11. Bradycardia, oliguria, edema appeared at a man, 20 years, in 2 months after
he carried craniocerebral trauma. At laboratory research: Na+ of blood - 108
mmol/1, K+ - 7,3 mmol/l.
I. Name hormone, related with this state?
____________________________________________________________________
____________________________________________________________________
2. Name the reasons and mechanisms of the indicated signs development.
10
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
12. Exhaustion, dry and wrinkled skin observed at the 27 years old woman, after
labors complicated by massive bleeding. Body temperature - 36°C, AP - 100/60
mmHg., glucose in the blood - 3,3 mmol/l, level of 17- ketosteroids in the urine is
decreased.
I. Name the pathology.
____________________________________________________________________
____________________________________________________________________
2. What are the basic mechanisms of it development?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________
Practical work:
Object of work: to show influence of the hypophysis posterior lobe on the urine
excretion.
EXPERIMENT № 1. Put three white mouse on the wire netting envisaged into glass
watering-cans with diameter 10-15 sm. Put the watering-cans into the test tubes for
collection of urine. Enter 2 ml of the distilled water in an abdominal region to two
mouses. Enter additionaly 0,2 ml of pituitrin (antidiuretic hormone, vasopressin)
under a skin one of them. The third mouse is control.
Loading by water
Loading by water
Control
+pituitrin
Determine a diuresis in all three mouses every 20 min. Diuresis after 1 our:
Control mouse
ml of urine
Mouse with the water loading
ml of urine
Mouse with water loading and pituitrin
ml of urine
Conclusion:
____________________________________________________________________
11
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
THEME: "PATHOLOGY of THYROID AND PARATHYROID GLANDS".
Actuality of theme. The height of thyroid gland pathology is observed in the
economic developed countries; in Ukraine it occupies one of the leading places.
Principal reasons of it origin is an action of ionizing radiation, deficiency of iodine in
an organism, genetic predisposition, age.
Pathology of the endocrine system occupies one of leading places in the structure of
diseases, which the doctor of any speciality meets with, first of all, physician and
pediatrician. Knowledge of reasons of origin, mechanisms of development, external
displays, features of motion, consequences matters in preparation of future
specialists.
General purpose of the lesson: to learn principal reasons and mechanisms of thyroid
and parathyroid glands pathology development.
For this it is necessary to know (the concrete purposes):

To explain the reasons of origin and mechanisms of development of basic
violations at the hyperfunction of thyroid and parathyroid glands.

To expose reasons and mechanisms of development of basic violations at
hypofunction of thyroid and parathyroid glands.
For realization of purposes of lesson it is necessary to have the base knowledgesskills:
1. To know the structure of thyroid and parathyroid glands (department of normal
anatomy, department of physiology)
2. To know the mechanisms of these glands action (department of physiology)
3. To know the methods of estimation of the functional state of thyroid and
parathyroid glands (department of physiology).
The checking of primary level of knowledges.
1. Name the hormones which are produced by a thyroid gland.
2. Physiological action of thyroid hormones.
3. What hormone is produced by parathyroid glands?
4. Physiological action of parathyroid gland hormone.
5. Regulation of thyroid gland hormones production.
6. Name the biological effects of thyroid gland hormones?
7. Reasons of thyrotoxicosis
8. What is endemic goitre?
9. Name the basic clinical sighs of thyrotoxicosis.
10. What violation develops as a result
of insufficiency of thyroid hormones at
12
children?
11. What are the reasons of acute hypoparathyroidism?
12. What are the reasons of chronic hypoparathyroidism?
13. Basic displays of chronic insufficiency of parathyroid glands.
14. Definition of hypoparathyroid tetany?
15.
16.
17.
18.
19.
20.
Name the complications of chronic hypoparathyroidism?
Name the reasons of hyperparathyroidism?
Name the basic displays of hypercalciemia?
What is the basic metaboism?
Level of calcium in the blood?
Level of phosphorus in the blood?
Standards of answers at the theoretical questions of initial level of knowledges:
1. Triiodothyronine (T3). thyroxine (T4), calcitoninum
2. Plays important role in regulation of height and differentiation of tissues,
influence on metabolism, and influence on CNS.
3. Parathormone.
4. Activation of osteoclasts function, oppression of phosphorus reabsorption,
activating of vitamin D transformation in active hormonal form.
5. By the thyreotropin (TTH) by the mechanism of direct and reverse connection.
6. Anabolic action, activation of protein synthesis, activation of metabolic, increase
reactivity of immune system and activation of antibodies production.
7. Main reason of thyrotoxicosis is the inherited predisposition; factors of risk are:
psychical trauma, infections, overcooling.
8. It is an enlargement of thyroid gland, connected with insufficiency of iodine in
water and earth, concern to some geographical region (mountains f.e.)
9. Enlargement of thyroid gland, exophtalmus, tachicardia, increase of basic
metabolism, decline of body mass, tremor of hands fingers, sweating, increased
nervous excitability, speed-up of intestine peristalsis.
10. Cretinism
11. Complete surgical removal of parathyroid glands, strumectomy concerning a
cancer.
12. Incomplete surgical removal of parathyroid glands, inherited hypoplasia,
intoxications, autoimmune damage, hemorrhages, tumors, inflammatory processes,
influence of ionizing radiation, intoxication, rachitis, for pregnant, in the period of
lactation.
13. Weight loss, anorexia, increased neuro-muscular excitability, dyspepsia, trophic
violations of skin and her appendages: dryness, thickening of skin, defects of dental
enamel, caries, and breaks of teeth.
14. It is arisen up at the complete surgical removal of parathyroid glands. It is
characterized by the increased neuro-muscular excitability as a result of diminishing
content of calcium in the blood: muscular rigidity, clonic and tonic convulsions.
15. Hypoparatliyroid cachexy.
16. Adenoma or hyperplasia of parathyroid gland.
17. Calcification of soft tissues, formation
of calcium stones in kidneys, hyperpiesis,
13
strengthening of gastric secretion.
18. Amount of energy, which is needed for maintenance of normal organism
functions at the minimum processes of metabolism (on empty stomach, t°C of
environment -18-19°C). For female - 1600-1700 ccal, for male - 2000 ccal.
19. 2,1-3.1 mmol/1
20.
0,0,9-1,2 mmol/1
Theoretical questions for FMC-2.
1. Thyroid gland. Hypothyroidism: causes and mechanisms of development,
pathogenesis of main disturbances in the organism.
2. Hyperthyroidism: Causes and mechanisms of development, pathogenesis of
main disturbances in the organism.
3. Goiter: kind (endemic, sporadic, diffuse and nodular toxic), their etiology and
pathogenesis, characteristic of functional state of the gland.
4. Parathyroid gland dysfunction: types, causes, mechanisms of development,
clinical and pathophysiological manifestations.
5. Hypofunction of parathyroid glands. Kinds. Reasons, mechanisms of
development. Basic manifestations.
6. Hyperparathyroidism. Reasons, mechanisms of development. Manifestations.
7. Hypothyroidism at children. Etiology, pathogenesis, manifestations.
Consequences.
Themes of abstracts:
 Autoimmune Hasimoto's thyroiditis.
 Radiation muddiness of Ukraine and pathology of thyroid gland.
 Pseudohypoparathyroidism. Reasons. Mechanisms of development.
 Thyrostimulating autoantibodies and their role in pathology of thyroid gland.
Literature.
1. Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005.
2. General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011
p.520-546
3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237
4. Lectures materials
Testing according Open database "KROK-I" (2010)
1. A 5-month-old boy was hospitalized for tonic convulsions.. Examination
revealed coarse hair, thinned and fragile nails, pale and dry skin. In blood: calcium –
1,5 millimole/l, phosphor -1,9 millimole/l. These changes are associated with:
a. Hypothyroidism
b. Hypoparathyroidism
c. Hyperparathyroidism
14
d. Hypoaldosteronism
c. Hyperaldosteronism
2.A child has abnormal formation of tooth enamel and dentin as a result of low
concentration of calcium ions in blood. Such abnormalities might be caused by
deficiency of the following hormone:
A. Thyroxin
B. Parathormone
C. Thriiodothyronine
D. Thyrocalcitonin
E. Somatotropic hormone
3.Clinical examination of a female patient revealed reduction of basal metabolism by
40%, gain in body mass, drop of body temperature, face puffines, sexual disfunctions,
inertness and apathy, lowered intelligence. These symptoms are caused by
dysfunction of the following endocrine gland:
A. Hypofunction of parathyroid glands
B. Hyperfunction of thyroid gland
C. Hypofunction of thyroid gland
D. Hypophysis hyperfunction
E. Epiphysis hypofunction
4.A 40 year old female patient has enlarged thyroid gland. On palpation the gland is
dense, its dense, its surface is slightly tuberous. Histological examination of flag
sample revealed diffuse in infiltration of tissue by the cells, formation of lymphoid
follicles. What disease is it?
A. Diffuse toxic goiter
B. Riedel’s disease
C. Autoimmune thyroiditis
D. Sporadic goiter
E. Endemic goiter
5.Clinical examination of a female patient revealed reduction of basal metabolism by
40%, gain in body mass, drop of body temperature, face puffiness, sexual disfunction,
inertness and apathy, lowered intelligence. These symptoms are caused by
disfunction of the following endocrine gland:
A. Epiphysis hypofunction
B. *Hypofunction of thyroid gland
C. Hyperfunction of thyroid gland
D. Hypofunction of parathyroid glands
E. Hypophysis hyperfunction
6.A 9 y.o. boy was admitted to the endocrinological department. This boy has already
15
had fractures of his extremities due to bone brittleness. The function of the following
endocrinal glands (gland) is disturbed:
A. Thymus
B.Thyroid
С Adrenal
D. *Parathyroid
E. Epiphysis
7.After a surgical procedure an experimental animal died from intense convulsions.
What endocrinal glands were extracted?
A.Adrenal
B.Ovaries
С Thyroid
D. *Parathyroid
E.Testicles
8.A patients from near Carpathians is suffering from the endemic goiter, turned to the
doctor with complaints on gum suppuration and loosened teeth. What is the cause of
parodontosis in this case?
A. * Endocrine malfunction
B. Stress influences
C. Hypersialosis
D. Swallowing malfunction
E. Malnutrition
9.Female, 53 years old, height 163 cm, body weight 92 kg, , edemata face, sedentary,
apathetic. When pressure is applied to the leg, the hollow remains. Which gland
dysfunction can cause such a state?
A. * Thyroid
B. Pituitary
C. Adrenal
D. Sexual
E. Parathyroid
10. A woman, 46 years, after the operation on the thyroid gland, soon experienced
fibrous muscles twitch of hands, legs and face. These dysfunction can be eliminated
by introducing
A. * Parathyroid hormone
B. Triiodothyronine
C. Thyrotropin
D. Thyroxin
E. Thyrotropic hormone
11.A woman, aged 45, a few years after moving to Trans-Carpathians developed
weakness, drowsiness, apathy, memory
16 decrease and swelling. After examination,
was diagnosed with endemic goiter. Lack of what substance in water and food could
lead to this disease?
A. * Iodin
B. Fluoride
C. Iron
D. Calcium
E. Magnesium
12.In patient, 20 years, following the surgical thyroid removal, enamel hypoplasia
and dentin formation malfunction were observed. Lack of which hormone has caused
the said diseases?
A. * PTH
B. thyroxin
C. thyrotropin
D. thyrotropin releasing factor
E. Thyrocalcytonin
13.A woman, aged 45, a few years after moving to Trans-Carpathians developed
weakness, drowsiness, apathy, memory decrease and swelling. After examination,
was diagnosed with endemic goiter. Lack of what substance in water and food could
lead to this disease?
A. * Iodin
B. Fluoride
C. Iron
D. Calcium
E. Magnesium
14.Patient D., 50 years, was diagnosed with myxedema. Malfunction of which
hormone formation leads to the development of this pathology?
A. * thyroxin and triiodothyronine
B. cortisol and aldosterone
C. ACTH and STH
D. oxytocin and vasopressin
E. insulin and glucagons
15.Clinical examination of a woman found: increased sweating, tachycardia, weight
loss, and tremor. What endocrine pathology can cause this?
A. * Hyperthyroidism
B. Hypothyroidism
C. Hypergonadism
D. Hypogonadism
E. Hypoaldosteronism
16. A 40 year old female patient has enlarged thyroid gland. On palpation the gland is
dense, its surface is slightly tuberous. 17
Histological examination of biopsy sample
revealed diffuse infiltration of tissue by the cells, formation of lymphoid follicles.
What disease is it?
A. Diffuse toxic goiter
B. Riedel’s disease
C. Autoimmune thyroiditis
D. Sporadic goiter
E. Endemic goiter
17. A child has abnormal formation of tooth enamel and dentin as a result of low
concentration of calcium ions in blood. Such abnormalities might be caused by
deficiency of the following hormone:
A.
B.
C.
D.
E.
Somatotropic hormone
Thyroxin
Parathormone
Thyrocalcitonin
Triiodothyronine
Situation tasks:
1. Acute worsening of the state, fever 39°C developed at a patient after the
subtotal resection of thyroid gland concerning toxic goitre of 3 degree. A patient
is excited, there are hallucinations, AP - 120/40 mm.Hg, heart rate - 180 /min,
breathing - 32 /min, arrhythmia.
1. What complication arises at a patient?
____________________________________________________________________
____________________________________________________________________
2. Explain the mechanisms of development.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Weakness, irritability, sweating arise up at a patient after the carried flu. A
patient became skinny; shaking of hands, goggle-eyedness appeared. At a
review: redness of face, skin moisture, exoftalmus, pulse - 120 /min, thyroid
gland is enlarged, soft, and painless.
1. What pathology takes place at a patient?
____________________________________________________________________
____________________________________________________________________
2. What reasons of this disease origin?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
18
____________________________________________________________________
3. Explain the mechanism of development
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. A woman, 60 years, long time was living near Carpatian mountains. She
complains on a presence of "tumor" on a neck during last 20 years. She is
displaced at swallowing. The tumor does not make any unpleasant feeling. At
research the bilateral diffuse goitre of 3 degrees was educed.
1. Name the pathology which takes place at a patient.
____________________________________________________________________
____________________________________________________________________
2. Does this disease connected with the place of living?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Name a "tumor" which grew in a woman. Explain the mechanism of it
development.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. What treatment should be used in this case?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. Woman, 68 years, hospitalized with the break of backbone. During 5 years
repeatedly there were breaks of backbone, bones of extremities. She feels
weakness, rapid fatigueability, gradually loses of weight. 2 years ago the stones
in the kidneys were educed. Objectively: pulse - 62 /min, respiratory rate - 17
/min, AP - 165/105 mmHg
1. Name the pathology which takes place at a patient.
____________________________________________________________________
____________________________________________________________________
2. What test she need to make?
____________________________________________________________________
____________________________________________________________________
3. Reasons of origin, mechanisms of development of this pathology?
____________________________________________________________________
19
____________________________________________________________________
5. A patient was operated concerning diffuse toxic goitre of 3 rd degree. In 2
weeks after operation convulsions of extremities muscles, paresthesia appeared
on hands and feet. Objectively: pulse - 72 /min, AP- of 120/80 mmHg, Skin is
moist. Tones of heart are rhythmic. Breathing is vesicular. From the side of
internals any deviations are not founded.
1. What complication did arise up at a patient?
____________________________________________________________________
____________________________________________________________________
2. What test it is necessary to make for confirmation of diagnosis?
____________________________________________________________________
____________________________________________________________________
3. What changes of homoeostasis did result this postoperative complication?
____________________________________________________________________
____________________________________________________________________
4. Was it possible to prevent it?
____________________________________________________________________
____________________________________________________________________
6. A patient, 46 years, long time felt fatigueability, bradycardia, pain in a
backbone muscles. At an inspection the level of calcium in blood more than 10
mmol/1, specific gravity of urine -1002-1009. Person use a meal rich on a
calcium.
1. Name the possible pathology.
____________________________________________________________________
____________________________________________________________________
2. What examination it is necessary to make for confirmation of diagnosis?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Does it dangerously for patient to use the meal rich on a calcium?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Practical work:
Object of work: to define the amount of calcium in the blood at experimental
hypoparathyroid tetany.
EXPERIMENT № 1. Determining the amount of calcium in blood.
Principle of method consists in sedimentation of serum calcium from by a lemon salt
ammonium. Lemon salt calcium that
20 is formed in a sediment determine by
manganese salt 0.0IN solution titration.
PROGRESS OF WORK.
Pour the test tube by 1 ml of serum, add 0,5 ml of the lemon salt ammonium saturated
solution. Mix the content of test tube and abandon on 30 min, centrifuge after it. Rack
a liquid above sediment. Add to sediment 3 ml of 2% NH 4OH, mix with test tubes
content and centrifuge again. Rack a liquid above sediment, wash by ammonia and
centrifuge once again. Add to sediment 1 ml of 10% of sulphuric acid, heat the test
tube on an water bath for dissolution of sediment and titrate it by 0,0 IN solution of
permanganate to the poorly-pink color, which does not disappear during 2 min.
Every ml of a 0,01N permanganate solution expended on titration conform to 0,2 mg
of Ca. Calculate the amount of calcium in 100 ml of the investigated blood serum. At
the same time determine the amount of calcium in a control test tube.
Results:
Control: for titration of control standard 0, 25ml of a 0,0 IN permanganate solution
were used.
1 ml - 0,2mg of Ca2+ 0,25 ml - x mg of Ca2+ x =0,05 mg of Ca2+
(In 100 ml of control serum there is 5 mg of Ca2+).
Experiment: for titration of experimental permanganate solution were used, lml - 0,2
mg of Ca2+
______ ml - x mg of Ca2+
x= _____ mg of Ca2+
(In 100 ml of the investigated serum there is
For translation the mg in mmol/1 use the coefficient 0,5. In the control standard
________________ x 0,5 = ___ mmol/1
Experimental model - _______ x 0,5 =
mmol/1
Conclusion
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
________________________________________________________________________
THEME: "PATHOLOGY OF ADRENAL GLANDS"./
Actuality of theme. Production of hormones, which play an important role in
maintenance of vascular tone, regulation of water-salt, carbohydrate, lipid
metabolism take place in adrenal glands.
It is extraordinarily important for future specialist to know etiologic factors
which result in development of adrenal glands hypo-, hyperfunction. Development of
acute insufficiency of adrenal gland is especially dangerous for life. Adrenal gland
pathology results in the pathology from the side of various organs and systems, both
organism of the grown man and child. Therefore understanding of mechanisms of
endocrine pathology basic manifestations development is a necessity for the doctor of
21
any profession.
A separate important question is a hypercorticoidism which develops as a
result of application of synthetic analogues of adrenal gland hormones during
antiinflammatory therapy. Knowledge of circadian rhythms of hormones production
will assist to the future doctors to make the correct setting of these hormones
analogues to prevent development of hypercorticoidism and "syndrome of abolition"
after stopping of medications reception.
General purpose of the lesson.
 To learn the reasons and mechanisms of adrenal gland pathology development.
 For this it is necessary to know (the concrete purposes):
 Pathology of the adrenal glands.
 Lack of adrenal cortex: types (primary, secondary, acute, chronic), etiology,
pathogenesis, clinical manifestations.
 Adrenal cortex hyperfunction: types (primary, secondary), etiology,
pathogenesis, clinical manifestations.
 Cushing's syndrome, Conn’s syndrome, congenital adrenal hyperplasia
(adrenogenital syndrome).
 Types, causes, mechanisms of development, clinical manifestations of the
medullar substance of adrenal glands disorders
For realization of purposes of lesson it is necessary to have the base knowledgesskills:
1.
To know the structure (anatomy) of adrenal gland (department of anatomy);
2.
To know the mechanisms of adrenal gland hormones action (department of
physiology and biochemistry);
3.
To know the hormonal regulation of metabolism and biological functions of
adrenal gland (department of biochemistry).
The checking of primary level of knowledges.
1.
Name the layers (parts) of adrenal gland.
2.
How many adrenal glands at human in a norm?
3.
What hormone of hypophysis regulates an activity of adrenal gland cortex?
What hormones are produced by the cortex of adrenal gland?
4. What hormones are produced by the medullar of adrenal gland?
5. Name the zones of adrenal gland cortex.
6. What hormones are produced by the zona fasciculata of adrenal gland?
7. What hormones are produced by the zona glomerulosa of adrenal gland?
8. What hormones are produced by the zona reticularis of adrenal gland?
9. Violation of what hormone synthesis results in Cushing's disease?
10. Violation of what hormone synthesis results in Cushing's syndrome?
11. Violation of what hormone synthesis results in pheochromocytoma?
12. Violation of what hormone synthesis results in Con's syndrome?
13. Violation of what hormone synthesis results in adrenogenital syndrome?
14. Violation of what hormone synthesis results in Addison's disease?
15. Name the Addison's disease by other
22 name.
16. Does the level of ACTH increase at Cushing's syndrome?
17. Does the level of ACTH decrease at Cushing's syndrome?
18. Does the level of ACTH increase at Cushing's disease?
19. Does the level of ACTH decrease at Cushing's disease?
20. Does the hyponatriemia develop decrease at Cushing's disease?
Does the hvperkaliemia develop decrease at Cushing's disease?
22. Does the edema develop at primary hyperaldosteronism?
23. Does the edema develop at secondary hyperaldosteronism?
24. Does the hypokaliemia develop at hyperaldosteronism?
25. Does the hyponatriemia develop at hyperaldosteronism?
Standards of answers at the theoretical questions of initial level of
knowledges:
1.
Cortex and medullar.
2.
Two.
3.
Adrenocorticitropin (ACTH)
4.
Glucocorticoids, mineralocorticoids,
sex hormones.
5.
Adrenaline, noradrenaline.
6.
Zona fasciculata zona glomerulosa
zona reticularis.
7.
Glucocorticoids.
8.
Mineralocorticoids.
9.
Sex hormones.
10. Increase of ACTH production.
11. Increase
of
glucocorticoids
production.
12. Adrenaline and noradrenaline.
13. Increase of aldosterone production.
14. Increase of sex hormones production.
15. Diminishing of adrenal cortex
hormones production.
16. Bronze disease.
17. No.
18. Yes.
19. Yes.
20. No.
21. No.
22. No.
23. No.
24. Yes.
25. Yes.
26. No.
21.
Theoretical questions for FMC 2.
1. Pathology of the adrenal glands. 23
2. Insufficiency of adrenal cortex: types (primary, secondary, acute, chronic), etiology,
pathogenesis, clinical manifestations.
3. Adrenal cortex hyperfunction: types (primary, secondary), etiology, pathogenesis,
clinical manifestations.
4. Cushing's syndrome, Conn’s syndrome, congenital adrenal hyperplasia
(adrenogenital syndrome).
5. Types, causes, mechanisms of development, clinical manifestations of the medullar
substance of adrenal glands disorders.
Themes of abstracts:
 Primary and secondary aldosteronism. Reasons of origin. Characteristics.
 Adrenogenital syndrome, its nosotropic variants.
 Stress and general adaptation syndrome.
 Violation of sex differentiation and puberty..
Literature.
1. Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005.
2. General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011
p.520-546
3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237
4. Lectures materials
Testing according Open database "KROK-1" (2010)
1. Osmotic pressure of blood plasma is 350 mosmole/l (standard pressure is 300
mosmole/l). First of all it will results in high secretion of the following hormone:
A
Vasopressin
B
Aldosteron
C
Cortisol
D
Adrenocorticotropin
E
Natriuretic
2. A concentrated solution of sodium chloride was intravenously injected to an
animal. This caused decreased reabsorption of sodium ions in the renal tubules.
It is the result of the following changes of hormonal secretion:
A
Aldosterone reduction
B
Aldosterone increase
C
Vasopressin reduction
D
Vasopressin increase
E
Reduction of atrial natriuretic factor
3. A patient with android-type of obesity had been suffering from arterial
hypertension, hyperglycemia, glycosuria for a long time and died from the
cerebral hemorrhage. Pathalogonatomic examination revealed pituitary
basophilic adenoma, and hyperplasia
24 of adrenal cortex. What is the most likely
diagnosis?
A
Cushing's syndrome
B
Diabetes mellitus
C
Acromegalia
D
Pituitary nanism
E
Adiposogenital dystrophy
4. Patient used glucocorticoids for a long time, discontinuation of using caused
decreased BP, weakness. How can you explain it?
A
Insufficiency of adrenal glands
B
Adaptation to the medicine
C
Sensitization
D
Hyperproduction of ACTH
E
Cumulation
5. The person has decreased diuresis, hypernatremia,
Hypersecretion of what hormone can cause such changes?
A
Aldosterone
B
Vasopressin
C
Auricular sodiumuretic factor
D
Adrenalin
E
Parathormone
hypokalemia.
6. A 50-year-old patient complains about general weakness, appetite loss and
cardiac arrhythmia. The patient presents with muscle hypotonia, flaccid
paralyses, weakened peristaltic activity of the bowels. Such condition might be
caused by:
A
Hypokaliemia
B
Hypoproteinemia
C
Hyperkaliemia
D
Hypophosphatemia
E
Hyponatremia
7. A 44-year-old woman complains of common weakness, heart pain, and
considerable increase of body weight. Objectively: moon-like face, hirsute
syndrome, AP- 165/100 mm Hg, height - 164 cm, weight - 103 kg; fat is mostly
accumulated in the region of neck, shoulders, stomach. What is the main
pathogenetic mechanism of obesity?
A
Increased production of glucocorticoids
B
Decreased production of thyroidal hormones
C
Increased production of insulin
D
Decreased production of glucagon
E
Increased production of mineralocorticoids
9. A 45 y.o. woman suffers from
25 Cushing's syndrome - steroid diabetes.
Biochemical examination revealed: hyperglycemia, hypochloremia. Which of the
under-mentioned processes is the first to be activated?
A
Gluconeogenesis
B
Glycogenolysis
C
Glucose reabsorption
D
E
Glucose transport to the cell
Glycolysis
10. The patient with complaints of permanent thirst applied to the doctor.
Hyperglycemia, polyuria and increased concentration of 17-ketosteroids in the
urine were revealed. What disease is the most likely?
A
Steroid diabetes
B
Insulin-dependent diabetes mellitus
C
Myxoedema
D
Type I glycogenosis
E
Addison's disease
11. On some diseases it is observed aldosteronism with hypertension and edema
due to sodium retention in the organism. What organ of the internal secretion is
affected on aldosteronism?
A
Adrenal glands
B
Testicle
C
Ovaries
D
Pancreas
E
Hypophysis
12. Examination of a patient revealed hyperkaliemia and hyponatremia. Low
secretion of which hormone may cause such changes?
A
Aldosteron
B
Vasopressin
C
Cortisol
D
Parathormone
E
Natriuretic
13. A patient has been given high doses of hydrocortisone for a long time. This
caused atrophy of one of the adrenal cortex zones. Which zone is it?
A
Fascial
B
Glomerular
C
Reticular
D
Glomerular and reticular
E
Situation task:
1. Arterial hypertension, hyperglycemia, lipopexia of upper part of body appear
at a patient suffered from adenoma26
of adrenal cortex.
1. Name the pathology.
____________________________________________________________________
___________________________________________________________________
2. Name the reasons and mechanisms of the indicated signs development.
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
2. The diagnosis of Con's syndrome made for a patient.
1. What are the reasons and mechanisms of this syndrome development?
____________________________________________________________________
___________________________________________________________________
Name the symptoms, that characteristic for this syndrome and mechanism of their
development.
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
2.
3. A man, 40 years, appealed to the doctor with complaints about the decline of
vision, periodic headache, arterial hypertension, polyuria. AT - 130/110 mm Hg.
Electrolytes of blood: Na+ - 175 mmol/I, K+ - 2,8 mmol/1.
1. Name the pathology for a patient?
____________________________________________________________________
___________________________________________________________________
Name the reasons and mechanisms of indicated signs development.
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
2.
4. A patient with chronic right ventricle insufficiency and cirrhosis of liver has
edema and arterial hypertension. At laboratory research a hypernatremia,
kaliopenia.
1. Name the reasons of this situation?
____________________________________________________________________
___________________________________________________________________
Identify mechanisms of development.
____________________________________________________________________
___________________________________________________________________
27
____________________________________________________________________
___________________________________________________________________
2.
5. Increase of aldosterone level in the blood was found at a patient with arterial
hypertension.
1.Name the reasons of this situation?
____________________________________________________________________
___________________________________________________________________
2.Name the biological effects of aldosterone.
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
6. A woman, 45 years, who used prednisolone for a long time due to bronchial
asthma. She complaints about the increase of blood pressure, appearance of
stretch strias at the abdomen, obesity of upper part of trunk.
1. Name the pathology for a patient?
____________________________________________________________________
___________________________________________________________________
Name reasons and mechanisms of it development.
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
2.
7. A woman with tuberculosis, suffered from general weakness, adynamia,
arterial hypotension, polyuria, diarrhea - appealed to the district doctor.
Objectively: hyperpigmentation of skin, glucose of blood of 3,5 mmol/1.
1. Name the pathology for a patient?
____________________________________________________________________
___________________________________________________________________
Name the reasons and mechanisms of the indicated signs development.
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
2.
9. A woman, 50 years, appealed to the doctor with complaints about the increase
of arterial pressure, especially after stress situations. At the USI there is increase
of right adrenal gland ( a medullar part).
1. Name the pathology for a patient? 28
____________________________________________________________________
___________________________________________________________________
2.
Name the reasons and mechanisms of the indicated signs development.
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
29
THEME: "PATHOLOGY of SEX GLANDS".
Actuality of theme. Pathology of sex glands results in violation of the main function
of human - generative. Thus there can be fruitlessness, violation of pregnancy
motion, delivery motion and other. Taking into account close connection of hormonal
function of sex glands with metabolism, violations of their function play an important
role in an origin of many organs diseases. That is why knowledge of sex glands
pathology (reasons of origin, mechanisms of development) has an important practical
value for the doctor of any profession.
General purpose of the lesson. For this purpose it is necessary to be able (concrete
aims):
1. To know biological effects and physiological action of sex hormones.
2. To explain the reasons of origin and mechanisms of basic manifestations
development at the hyperfunction of sex glands.
3. To explain the reasons of origin and mechanisms of basic manifestations
development at the hypofunction of sex glands.
For this it is necessary to know (the concrete purposes):
To know the structure of sex glands (department of human anatomy, department
of histology)
To know the mechanisms of these glands hormones action (department of
physiology)
To know the methods of the functional state of sex glands diagnostics (department
of physiology).
The checking of primary level of knowledges.
1. Name the hormones which are produced by the ovaries.
2. Name the cells which are responsible for the female hormones synthesis.
3. Physiological action of the female hormones.
4. What physiological value of progesterone?
5. Name the hormones which are produced by the testis.
6. Name the cells which are responsible for the male hormones synthesis.
7. Physiological action of the male hormones.
8. Name the age of puberty formation.
9. What does behave to the primary sex signs?
10. Significance of primary sex signs.
11. What belongs to the secondary sex signs?
12. Name the extragenital effects of sex glands.
13. Explain the regulation of synthesis of sex hormones.
30
14. Physiological action of placenta hormones.
15. What belongs to the protein hormones of placenta?
16. What belongs to the steroid hormones of placenta?
17. Name the biological effects of chorionic gonadotropin.
18. Name the biological effects of somatomammotropin.
19. What
is virilism?
20. What are the reasons of virilism?
21. Name the main clinical sign of virilism?
22. What is castration?
23. Name the reasons of castration?
24. What are the main clinical sign of castration?
25. What do the consequences of castration depend on?
26. What is postcastration syndrome?
Standards of answers at the theoretical questions of initial level of knowledges:
1.
Estrogenes (estradiol, estrone, estriole). progestines (progesterone).
2.
Cells of yellow body and placenta.
3.
Growth and maturation of genital organs, growth of oviducts, uterus, vagina,
formation of internal layer of uterus (endometrium), formation of secondary female
signs and manifestations of sex reflexes, acceleration and uterus muscles contraction,
sensitisation of uterus to oxytocine, growth and development of mammary glands.
4.
Provides normal motion of pregnancy, growth of endometrium which assists to
implantation of the impregnated ovule in an uterus, creates favorable conditions for
development of decidual membrane, brakes contraction of pregnant uterus muscles,
diminishes the sensitiveness of uterus to oxytocine and estrogenes, brakes growth and
maturation of follicles, assists to the accumulation of water and electrolytes in the
uterus tissues and in the all organism, promotes growth and uterus stretching,
formation of mammary gland.
5.
Androgens (testosterone).
6.
Interstitial cells (Leydig's cells).
7.
Growth and maturation of genital organs, normal maturation of spermatozoons,
maintenance of their motive activity, exposure and realization of sexual behavioral
reactions, influence on metabolism, strengthening of proteins synthesis in different
tissues, especially in muscles, diminishing of fat content in the organs, increase of
basic metabolism, influence on the CNS functional state.
8.
12-16 years
9.
Sex glands (testis, ovaries), genital organs.
10.
Determine possibility of coitus and procreation realization
11.
Change of body form, timbre of voice, growth of hair, development of
mammary glands, and also psychical behavior.
12.
Anabolic action of androgens, catabolic action of progesterone, influence of
androgens and gestagenes on the bones growth, increase of basal body temperature
13.
With help of folliculostimulating hormone and luteinizing hormone by the
principle of positive and negative feed-back.
14.
Connection of maternal organism
with a fetus, formation of enzymes,
31
proteolysis, lipolysis, protein and steroid hormones formation.
15.
Chorionic gonadotropin, somatomammothropin, relaxine
16.
Progesteron and estriole
17.
Luteinizing action, stimulates the growth of ovaries follicles, determines
ovulation of mature follicles, assists of yellow body formation in ovaries, stimulates
formation of progesterone in a yellow body, and prevents premature detachment of
embryon, antiallergic action.
18.
Influences on the mammary gland of pregnant, promotes a proteins synthesis
and detains nitrogen in the organism of mother, increases content of free fat acids,
promotes resistance of an organism to the hypoglycemic action of insulin.
19.
Appearance of the secondary male sex signs at female.
20.
Androgenic-productive tumors of ovaries and adrenal gland increase synthesis
of this hormones at the diseases of untumour origin (Cushing's disease. acromegaly.
Shtain- Levental's syndrome).
21.
Hair distribution on a male type, rough voice, male constitution, atrophy of
mammary glands
22.
Influence that causes the complete and unrevised stopping of sex glands
function.
23.
Trauma, infection that are accompanied with destruction of sex glands tissues,
surgical removal, hormonal and radial influence.
24.
Malignant tumors of testicles and prostate, malignant tumors of ovaries, cervix
of uterus, mammary glands.
25.
Depends from the age in which the endocrine function was disturbud - before
the puberty or after it.
26.
Complex of pathological changes which arise up in an organism as a result of
castration.
Theoretical questions for FMC 2
1. Male hypogonadism, reasons, mechanisms of development, basic manifestations.
2. Female
hypogonadism, reasons, mechanisms of development, basic
manifestations.
3. Male hypergonadism, reasons, mechanisms of development, basic manifestations.
4. Female
hypergonadism, reasons, mechanisms of development, basic
manifestations.
5. Hypogonadism at a boys. Reasons of origin. Description.
6. Hypogonadism at a girls. Reasons of origin. Description.
7. Adrenogenital syndrome. Reasons of origin. Mechanisms of development.
Description.
8. Hermaphroditism.
Kinds. Reasons, mechanism of development, basic
manifestations. Consequences.
Themes of abstracts :
 Adrenogenital syndrome, its nosotropic variants.
 Violation of sex differentiation and puberty.
 Hyperandrogcnism.
32
 Primary and secondary amenorrhea.
 Gynecomastia.
Literature
1. Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005.
2. General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011
p.520-546
3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237
4. Lectures materials
Testing according Open database "KROK-1" (2010) 1. A girl has been diagnosed with adrenogenital syndrome
(pseudohermaphroditism). This pathology is caused by hypersecretion of the
following adrenal hormone:
A.
*Androgens
B.
Glucocorticoids
C.
Catecholamines
D.
Estrogens
E.
Mineralocorticoids
A young man aged 17 has the signs of retention of sexual development; his height
is 184 cm; he is asthenic; his secondary sexual characters are weakly developed. Sex
chromatin is absent in this patient's cells. At the age of 4 he endured epidemic
parotitis. What was the cause of hypogonodism?
A.
Deficiency of gonadoliberine
B.
Deficiency of gonadotropin
C.
Cryptorchism
D.
* Orchitis
E.
Chromosomal anomalies (XXY)
2.
Removal of cancer tumor of the testis in a patient before the period of sexual
maturity resulted in the development of eunochoidism and was accompanied by the
deficiency of the production of:
A.
* Androgens
B.
Estrogens
C.
Kinines
D.
Prostaglandins
E.
Cytokines
3.
A boy, 14 years old, visited endocrinologist. His mother complains of his being
behind in physical development and 33
growth. The boy has proportional constitution,
his is 104 cm tall, and his secondary sexual characters are not marked. The cause of
this pathology is hyposecretion of:
A.
* Gonadotropic hormone
B.
Growth hormone
C.
All hormones of adenohypophysis
4.
D.
E.
ACTH
Thyroid stimulating hormone
When stomatological examining the patient the following symptoms were revealed:
woman features of his face, anomalies of form of crowns in some teeth, catarrhal
gingivitis, and resorption of interdental junctures. Cytological examination of mucous
membrane epithelium discovers that cells contain 1 Barr's body. What endocrine
pathology are these manifestations the most probably connected to?
A* Hypogonadism
B.
Hypergonadism
C.
Cretinism
D.
Thyrotoxicosis
E.
Chronic hypoparathyroidism
5.
What pathological conditions the tumor growing from reticular zone of adrenal
gland may lead to?
A.
* Virilization of female organism
B.
Elevation in content of glucocorticoids in blood
C.
Tachycardia
D.
Elevation of content of mineralocorticoids in blood
E.
–
6.
Parents of a 10 y.o. boy consulted a doctor about extension of hair-covering,
growth of beard and moustache, low voice. Intensified secretion of which hormone
must be assumed?
A.
Of progesterone
B.
*Of testosterone
C.
Of oestrogen
D.
Of somatotropin
E.
Of Cortisol
7.
A girl is diagnosed with adrenogenital syndrome (pseudohermaphroditism). This
pathology was caused by hypersecretion of the following adrenal hormone:
A.
Cortisol
B.
Adrenalin
C.
Aldosterone
D.
Estrogen
E.
*Androgen
8.
Parents of a 10 year old boy consulted
a doctor about extension of hair-covering,
34
growth of beard and moustache, low voice. Intensified secretion of what hormone
must be assumed?
A.
*Of testosterone
B.
Of somatotropin
C.
Of progesterone
9.
D.
E.
Of Cortisol
Of oestrogen
Situation task:
1. The patient, 16 years, complained of obesity, headaches, dizziness. These
complaints appeared about 2 years ago. During the previous period they
increased. In anamnesis there is chronic tonsillitis. On examination: height - 168
cm, weight 95 kg. On the sides of the abdomen, inner surface of the thighs, the
waist area, there are blue and purple striae. Folliculitis. Obesity of android type.
BP - 150/100 mm.Hg.
1. What is the disease at the patient?
____________________________________________________________________
___________________________________________________________________
2. Level of what hormones should designate a patient?
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
2. The woman, 37 years, proportionale constitution, female type, complaining of
irregular menstruations (delay of 4-6 months), deterioration of health: frequent
feeling of stuffy and hot, "hot flash", transient increase of blood pressure,
weight gain. In anamnesis - 2 pregnancies that ended in normal births.
1. Put a preliminary diagnosis.
____________________________________________________________________
___________________________________________________________________
What is the mechanism of these symptoms?
____________________________________________________________________
___________________________________________________________________
3.
3. The patient, 19 years, as a child was often ill on infectious diseases. Objective:
height 180 cm, asthenic physique, secondary sexual characteristics are
underdeveloped, the primary sex characteristics do not satisfy the age, the testes
atrophied. Testosterone levels in the blood is reduced.
1. Put a preliminary diagnosis.
____________________________________________________________________
___________________________________________________________________
35
2. What is the mechanism of these symptoms?
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
Practical work:
Object of work: to show activation of sex apparatus of a frog ander the action of
gonadotropic hormones.
EXPERIMENT № 1. Identification of pregnancy early terms.
Enter into the spinal lymphatic sack of
two frogs-males with the absent sperm
cell 3-4 ml urine of pregnant woman
urine by the syringe. Take the liquid
from the frog's cloaca by the pipette
after 1-1,5 hours from and prepare the
specimen - the "hanging drop". Look
over it under a microscope. Presence of
sperm cell confirms the pregnancy.
Watch the motion of с sperm cell and
infusoria. As opposed to the infusoria
the sperm cells do not make the direct
motions,
but
pendulous.
For
comparison examine the liquid from
cloaca that was taken before the
entrance of pregnant woman urine
(control test).
Conclusion:
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
EXPERIMENT 2. Influence of pregnant woman urine at the sex development of the
infantile mouse (Aschheim-Zondek test).
Macropreparations got on early conducted experiment on the infantile mise with the
pregnant woman urine are demonstrated to the students.
Aschheim-Zondek test
Enter 0,3 ml of urine under the skin to the infantile mise-females during 3th days.
Prepare the smears from vagina content in 100 hours after the first injection. Fix the
smears by the alcoholic ether. Paint 36
them by the Romanovskyy's method or by the
0,5% solution of methylene blue Investigate the smears under a microscope. Expose a
characteristic microscopic picture. Then mise it is hammered in, unseal an abdominal
region and determine the state of the sex system.
Megascopic horns of uterus and the megascopic ovaries with the areas of fresh
hemorrhages and in less yellow bodies are appear that testifies to the premature
ripening of follicles.
For control mise - the horns of uterus are very thin, ovaries are pale and barely
noticeable among fatty tissue.
Students examine the smears under a microscope,
sketch changes, characteristic for the different stages of
estrus.
- resting stage (dioestrus)
- prooestrus
- oestrus
- metoestrus
37
THEME: "PATHOLOGY OF NERVOUS SYSTEM. PATHOPHYSIOLOGY OF PAIN".
Actuality of theme. The nervous system regulates not only motive activity and
sensitiveness of an organism, makes the regulation of all systems and organs, forming
of human output, conditioned reflex, but also provides protective reactions. For
example, pain is the unpleasant sensory and emotional feeling, related to the threat or
damage of tissues. Understanding of mechanisms of pain forming is very important
for an practical doctor, as the important aspect of diseases nosotropic treatment and
pathophysiological basis of anesthesiology.
General purpose of the lesson. To learn the reasons and mechanisms of pain.
For this it is necessary to know (the concrete purposes):
1.
To know general descriptions of the nervous system.
2.
To know physiological basis of pain.
3.
To know basic electro-physiological processes in the neurons.
4.
To know the features of blood supply of cerebrum.
For realization of purposes of lesson it is necessary to have the base knowledgesskills:
1.
Structure (anatomy) of the nervous system (normal anatomy department);
2.
Physiology mechanisms of pain (physiology department);
3.
Electro-physiology processes in the brain (physiology department)
Checking of primary level of knowledges.
Give the answers to the following questions.
1. What is the pain?
2. Name types of pain?
3. What is somatic pain, its characteristics.
4. What is visceral pain, its characteristics.
5. Name the basic models of motive function violations in an experiment.
6. Name the basic syndromes of motive function violations.
7. What is the paralysis, paresis?
8. Types of the paralyses, paresises?
9. What is the myasthenia?
10. What is the Parkinson's disease?
11. Name the hyperkinetic violations of motive function?
12. What is die convulsions? Name the kinds.
13. What is the vasoneurosis ?ВСД на англ.?
14. What is the neurogenic dystrophy?
15. What is the stroke?
38
16. Name the chronic violations of cerebral blood circulation.
17. Name the violations of integrative function of CNS?
Standards of answers at the theoretical questions of initial level of knowledges:
1.
Pain is the unpleasant sensory and emotional feeling, related to the threat or
damage of tissues.
2.
According to clinical manifestations the pain can be: acute, dull locate and
diffuse, to have the character of pricking, aches and other.
According to duration the pain can be: acute and chronic. According to the value for
an organism: physiological and pathological. According to the mechanism of
development the pain can be: somatic and visceral. According to the location the pain
can be: local, projective, radiating pain.
3.
Somatic profound pain - is the kind of pain that is forming in the profound
tissues. F.ex.: headache, dentalgia, myalgia, pain in the joints. Somatic superficial
pain - is the kind of pain that is forming in the skin.
4.
Visceral pain - is the kind of pain that is forming in the internal organs.
5.
Basic models: cutting of peripheral nerves and ventral root of spinal nerve
(peripheral paralyses); damage of spinal cord (spinal shock); cutting of brainstem
between of mesencephalon and medulla oblongata (decerebrative rigidity); removal
of cerebellum; cutting of pyramidal tracts; damage of extrapyramidal structures;
removal or electric stimulation of motive zone of brain cortex.
6.
Basic syndromes of violation of motive functions: violation of neuromuscular
transmission, peripheral paralyses and paresises, central paralyses and paresises,
Parkinson's disease, hyperkinesias, cerebellar tentorial syndrome.
7.
Paralysis - it complete, and paresis is a partial loss of voluntary movement.
8.
A central paralysis arises up at the damage of central motive neuron. It is
characterized by muscular hypertension, hyperreflexia, appearance of pathological
reflexes. A peripheral paralysis arises up at the damage of peripheral motive neuron.
Signs: hypo- or atony, areflexia, atrophy of muscles.
9.
Myasthenia is the inherited disease which appears as a muscular weakness;
rapid fatigueability resulted by the blockade of neuromuscular transmission. In the
base of it there is diminishing of acetylcholine receptors amount.
10.
Parkinson's disease is the one from hyperkineticohypertonic syndrome, based
on violation of dopamine synthesis. Basic displays are: hypokinesia, tremor, muscular
rigidity.
11.
Hyperkinetic violations of motive function are chorea, athetosis, hemiballism.
12.
Convulsions are voluntary contractions of skeletal muscles that have
paroxysmal character. There are tonic and clonic convulsions, combined. Depending
on prevalence - general and local.
13.
Vasoneurosis is the generalized violations of the vegetative nervous system.
14.
Neurogenic dystrophy is a complex of trophic violations in organs and tissues
that arises up at the damage of nerves
39 or other structures of the nervous system.
Combined with the structural violations, functional changes, metabolic disturbance.
15.
Stroke is the acute disorder of cerebral blood circulation that results in proof
violations of cerebrum functions. There are hemorrhagic stroke (hemorrhage in a
brain) and ischemic stroke (ischemia of brain).
Chronic violations of cerebral blood circulation are vascular encephalopathy
that arises up as a result of atherosclerosis, results in dystrophic changes.
17.
Violation of integrative function are agnosia (violation of feeling and
perception), aphasia (disorder of consciousness, thought, speech), violation of
behavioral responses, emotions, motivations, violation of capacity for studies,
amnesia, parahypnosis.
16.
Theoretical questions for FMC -2.
1.
General characteristic of the nervous system pathology, principles of classification of
nervous system violations. Features of typical pathological processes of the nervous
system.
2.
Violation of sensory functions of the nervous system. Disorders of mechanical,
thermal, and proprio-, nociception. Violation of sensory information. Brown-Sekar’s
syndrome. Manifestations of thalamic centers and sensory structures of the cerebral cortex
injury.
3. Pain. Features of pain as a kind of sensitivity. Principles of pain classification.
Somatic pain. Visceral pain. Modern conceptions about the causes and pathogenesis of pain:
theory of impulses redistribution (“gate theory”), theory of specificity. Pathological pain:
neuralgia, causalgia, phantom, thalamic. Peripheral, peripheral - central and central
mechanisms of pathological pain. Emotional, autonomic, motor body's response to the pain.
Emotional-painful stress, pain shock. Natural antinociceptive mechanisms. Principles and
methods of analgetic therapy.
4.
Disorders of motive function of the nervous system. Experimental modeling of
movement disorders. Peripheral and central paresis and paralysis: causes, mechanisms of
development, main manifestations. Spinal shock. Movement violation of subcortical origin.
Violations related to lesions of the cerebellum. Convulsions and their kind. Violation of
neuromuscular transmission. Myasthenia.
5.
Disorders of vegetative nervous system functions, methods of experimental
modeling. Vegetovascular dystonia syndrome.
6.
Violation of trophic function of the nervous system. Neurogenic dystrophy. Etiology
and pathogenesis.
7. Violation of integrative functions of the central nervous system (CNS). Causes and
mechanisms of electrophysiological processes in neurons disorders. Disruption of ion
channels. Causes and mechanisms of the neurochemical processes disorders. Disorders of
neurotransmitters, neuromodulators, neurohormons functions. Morbid excitation and
inhibition of pathological nerve centers. Neuroses.
8. Damage of the neurons as one of the reasons of violations of integrative functions of the
CNS.
9. Acute and chronic disorders of cerebral circulation. Stroke. Edema of the brain, causes
and mechanisms of development. Intracranial hypertension. Damage of neuroglia in the
development of pathological processes of the CNS. Brain barrier damage and
40
autoimmune brain injury.
Literature.
1.
Handbook of general and
prof.A.V.Kubyshkin, CSMU, 2005.
Clinical
Pathophysiology/
Edited
by
General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011
p.520-546
3.
Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237
4.
Lectures materials
2.
Testing according Open database "KROK-1" -2010
1. A patient after hypertension stroke does not have voluntary movements in his
right arm and leg with the increased muscle tone in these extremities. What type
of dysfunction of nervous system is it?
A Central paralysis
B Peripheral paralysis
C Peripheral paresis
D Reflex paresis
E Central paresis
2. Four months ago a 43 year old patient had a traumatic amputation of his
lower extremity. Now he complains of sensing the amputated extremity and
having constantly grave, sometimes unbearable pain in it. What type of pain
does he have?
A Phantom
B Causalgia
C Neuralgia
D Thalamic
E Reflex
3. After poisoning with an unknown drug a 37 year old patient has stereotypical
face muscle contractions that imitate blinking and squinting. What form of
motor function disorder of nervous system is it?
A Hyperkinesia
B Hypokinesia
C Akinesia
D Ataxy
E4. After traumatic tooth extraction a patient complains of a severe dull pain
without accurate localization in his gum, body temperature rise up to 37,50С. He
was diagnosed with alveolitis. What type of pain does the patient have?
A Protopathic
B Epicritic
41
C Visceral
D Referred
E Phantom
Testing according system “Krok-I” (2006-2010)
1.After amputating the upper extremity a patient had a bad pain in it. Which
mechanism of the pain feeling formation is more possible in this case?
A.
*Phantom
B.
Reflex
C.
Hyposecretion of endorphin
D.
Hypersecretion of endorphin
E.
Hyposecretion of encephalin
After a road accident a patient was diagnosed with a trauma of the brachium with
incomplete rupture of the median nerve. Besides, disorders of the motor and sense
functions, the patient complains of sharp, stinging, intolerable pain. What kind of
pain is it?
A.
Somatic.
B.
Projective.
C.
Reflected.
D.
Phantom.
E.
*Causalgia.
2.
3. A patient, complaining of pain in the region of the left scapula, was diagnosed with
myocardial infarction. What kind of pain is it?
A Phantom.
B. Visceral.
С *Irradiating (reflected).
D.
Early (protopathic).
E.
Late (epycritical).
4.An experimental rat with extremity paralysis has no tendon and cutaneous reflexes,
muscle tone is decreased, but muscles of the affected extremity maintain their ability
to react with excitation to the direct action of continuous current. What type of
paralysis is it?
A Flaccid peripheral
В Flaccid central
С Spastic peripheral
D Spastic central
E Extrapyramidal
5.A 28 year old man had a gunshot wound of shin that resulted in an ulcer from the
side of the injury. What is the main factor of neurodystrophy pathogenesis in this
case?
42
A *Trauma of peripheral nerve
В Psychical stress
С Microcirculation disturbance
D Infection
E Tissue damage
6. After a hypertonic crisis a patient presents with lacking spontaneous movements in
his right arm and leg, muscle tone of these extremities is increased. What type of
motor dysfunction has developed in this case?
A. Peripheral paralysis
B. *Central paresis
C. Central paralysis
D. Peripheral paresis
E. Reflectory paresis
Name the pathology of motive function of nervous system and reasons
of origin?
43
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
Situate task:
1. Myocardium infarction was diagnosed at a patient, 48 years, who complains
on pain in an abdominal region.
1. Name the type of pain?
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
What are the basic mechanisms of it origin?
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________
2.
2. A patient, complaints on a general weakness, nausea, pain at the bottom of
abdomen. Acute appendicitis was diagnosed after the review.
1. Name the type of pain?
____________________________________________________________________
___________________________________________________________________
44
2. What are the basic mechanisms of it origin?
____________________________________________________________________
___________________________________________________________________
____________________________________________________________________
___________________________________________________________________